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Detection and recognition of hypertension in anxious and depressed patients

Byrd, James B.a; Powers, J. Davidb; Magid, David J.b; Tavel, Heather M.b; Schmittdiel, Julie A.c; O’Connor, Patrick J.d; Beck, Arne L.b; Butler, Melissa G.e; Ho, Pei-Jai M.f

doi: 10.1097/HJH.0b013e328359b6e6

Objective: Hypertension management requires detection (i.e. confirmation of persistently high blood pressure (BP) after an initial elevated measurement) and recognition of the condition (evidenced by a formal diagnosis and/or initiation of treatment). Our objective was to determine whether disparities exist in detection of elevated BP and recognition (i.e. diagnosis or treatment) of hypertension in patients with depression and anxiety.

Methods: Using data from the Cardiovascular Research Network Hypertension Registry, we assessed time-to-detection of elevated BP and recognition of hypertension in patients with comorbid anxiety and depression compared with patients with neither disorder. We performed multivariable survival analysis of time to detection and recognition in patients who entered the registry in 2002–2006. We adjusted for primary care visit rate and other relevant clinical factors.

Results: In 168 630 incident hypertension patients, detection occurred earlier among patients with anxiety and depression compared with patients without these diagnoses [adjusted hazard ratio for anxiety and depression 1.30, 95% confidence interval (CI) 1.26–1.35]. Recognition of hypertension within 12 months of the second elevated BP was similar (adjusted hazard ratio for anxiety and depression 0.94, 95% CI 0.89–1.00) or delayed (adjusted hazard ratio for anxiety 0.93, 95% CI 0.88–0.99 and for depression 0.93, 95% CI 0.90–0.97).

Conclusions: Detection of elevated BP occurred earlier in patients with anxiety and depression. Time from detection to diagnosis or treatment was similar or delayed in patients with and without these diagnoses. Our findings suggest that as-yet-unidentified factors contribute to disparities in hypertension detection and recognition.

aDepartment of Medicine, University of Michigan Medical School, Ann Arbor, Michigan

bKaiser Institute for Health Research, Denver, Colorado

cKaiser Permanente Division of Research, Oakland, California

dHealthPartners Research Foundation, Minneapolis, Minnesota

eKaiser Permanente Georgia, Center for Health Research - Southeast, Atlanta, Georgia

fDepartment of Medicine, Denver VA Medical Center, Denver, Colorado, USA

Correspondence to James B. Byrd, MD, MS; Division of Cardiology, Department of Medicine; Room 20-209W, NCRC, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA. Tel: +1 734 615 3878; fax: +1 734 764 4142; e-mail:

Abbreviations: BP, blood pressure; CI, confidence interval; CVRN, cardiovascular research network; HR, hazard ratio; ICD-9-CM, international classification of disease, 9th revision, clinical modification; IQR, interquartile range

Received 18 June, 2012

Revised 14 August, 2012

Accepted 24 August, 2012

© 2012 Lippincott Williams & Wilkins, Inc.